Dr. Usal is affiliated withBella Tu MedSpa where he treats
patients for laser and non-invasive
facial and skin rejuvenation.
He provides Botox and filler injections with Juvéderm, Perlane, Restylane,
and Radiesse.

To get the most benefit from you body enhancement surgery, Dr. Usal recommends MDFatLoss.com's program directed by Dr. Ohan Karatoprak, before and after your surgery. Read more …

In “I Feel Bad About My Neck,” Nora Ephron gave voice to generations of women who have been silently hiding their necks like turtles in scarves, boas, turtlenecks and chokers. Her blunt advice is to start concealing the neck at age 43. “Our faces are lies and our necks are the truth. You have to cut open a redwood tree to see how old it is, but you wouldn’t if it had a neck.” Sure, she had a point. But there is an equal embarrassment perched right above the neck: the sagging jaw line.
When you reach your early 40s, you may notice that the skin between your neck and jaw, which was once a taut right angle, is now simply dropping. This “drop zone” is the subject of many heart-to-heart conversations. We have all watched at least one friend (of a certain age) pulling back the skin in front of her ears with two thumbs to illustrate how much better she would look without the drooping, wavy jaw line. She asks, “Tell me the truth, don’t I look better like this?” You answer dishonestly: “Don’t be silly. You look great the way you are.”

The aging jaw and neck are challenging. The neck is comprised of three layers: skin, fat, and muscle. Sagging muscles and bulging fat are located under the thinnest, crepiest skin on the body (except for eyelid skin). To make matters worse, a thin ropey material called platysma tends to split into a V-like formation of two cords that stick out especially when they contract. To see this phenomenon in action (if you’re over 40) look in a mirror, say “eee,” and watch in horror what happens. A Manhattan plastic surgeon comments, “Trying to fix all of that with potions and lotions is like waging a two-front war on a sheet of thin ice.” He recommends a neck lift for women in their early to mid-40s who are not ready for a facelift.

Neck Lift/Facelift
The neck lift wraps sagging muscles crosswise to the jaw to restore that all-important right angle. Compared with a facelift, sutures are smaller, there is less pulling and recovery time is much shorter. However, a neck lift has traditionally been part and parcel of a facelift and many plastic surgeons believe it should remain so. The reasoning is that, anatomically, the muscles of the neck are connected to muscles of the face, so if you try to tighten just the neck muscles, you will do you face a disservice. Using this line of reasoning, even if your big complaint is your neck, you will get better results with a facelift. If you’re confused about which procedure is right for you, have a board-certified plastic surgeon, or two, give you feedback while perusing your very own unique face and neck.

Liposuction and the double chin
The face and neck are usually treated at the same time, often in conjunction with liposuction to sculpt the area beneath the chin and jaw line. But, if you gain weight, looser skin, weaker muscles and free falling fat may contribute to your drop zone. Younger patients who have fatty necks but no significant facial aging may be treated with liposuction alone. Some plastic surgeons also might use laser or light technology to tighten necks.

Preventive Botox
It has been seen that using Botox in areas where wrinkling and creases can occur will prevent deeper lines from forming and will maintain a youthful appearance. Better to not have those angry or tired lines develop, so people will not notice that you’ve had anything done. Botox can also soften those V-shaped platysma cords.

Your own belly fat
Another alternative is injecting fat from the belly into the jawline area to provide extra volume. This will include the bonus of your own stem cells. Extra stem cells are separated from the fat via centrifuge and then added, making the skin glow more and enhancing collagen.

Trendy approaches
Plastic surgeons were recently interviewed by W Magazine about trendier devices, such as Thermage, Ulthera and Titan. These devices deliver radio frequency, ultrasound and infrared lasers to stimulate skin layers below the epidermis, an area in which collagen and elastic production slows down as we get older. According to the surgeons interviewed the problem is that these devices don’t deliver enough energy to have a substantial effect. However, if you have mild laxity and expect modest results, they may be a good option.

A new FDA-approved radiofrequency device, Evolastin, has been getting some good reviews. Evolastin delivers heat through small injections directly into the deep dermis. The goal is to boost collagen and elastin. A typical treatment can include as many as 1,500 shots via pulses from a 10-needle cartridge; local anesthesia is used or else the pain would be unbearable. You also need patience; the results take over one month to see and then continue to appear for a year. One doctor claims the boost of elastin and collagen produced by Elastin is like setting the clock back about five years and that results are equal to about one third of a facelift. If you choose this procedure, ask a lot of questions about the recovery time. There have been reports of post treatment swelling that can persist for some time.

In still another approach, a company called Kythera is close to releasing an injectable that dissolves the double chin with human bile.
Even though you might favor one of these options, it’s a good idea to have an open mind when you go in for a consultation. Your best bet is to come in for a consultation where we can suggest the very best procedure in view of your very own unique facial characteristics.